Disclosures: Jessica Kao, DO: No financial relationships or conflicts of interest

Case Description: The patient had a history of hypertension and hyperlipidemia and presented after a head-on motor vehicle collision. Imaging showed C6 transverse process fracture and C5-6 fracture dislocation with retrolisthesis of C5 on C6, along with ligamental disruption and edema. She also had focal short segment traumatic dissections of bilateral vertebral arteries at C5-C6 with up to 90% stenosis on the left and 40% stenosis on the right. She was started on aspirin, and underwent open reduction and internal fixation of the C5-6 fracture along with cervical fusion of C3-T2 with Neurosurgery.

Setting: Inpatient Rehabilitation Center

Patient: 74-year-old female with vertebral artery dissection and cervical fracture after motor vehicle collision Assessment/

Results: The patient had right upper extremity weakness and diminished sensation along the C6-7 dermatome, consistent with a C5 AIS D diagnosis. Since she was right-handed, she initially required moderate to total assist with most self-care tasks but eventually progressed to moderate assist to supervision. During her rehab course, she also had dizziness, which is a known symptom of vertebral artery injury but was complicated by the patient being on an antihypertensive medication regimen.

Discussion: The incidence of traumatic vertebral artery injuries (TVAI) in literature is rare and varies from 0.5 to 2% of trauma admissions. However, these injuries may be present in 20% of patients with head injuries and up to 70% of patients with cervical spine fractures. Unilateral injuries are also more common, accounting for about two-thirds of cases. Many treatment options are available, including observation, anticoagulation, and surgery. TVAIs can have severe complications, with almost 40% mortality in cervical spine injury patients.

Conclusion: Although vertebral artery injury is rare in trauma patients, it is more prevalent in patients with cervical fracture. Since patients can often be asymptomatic, prompt diagnosis and treatment can reduce further risk of injury and complications.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-traumatic-vertebral-artery-injury-along-with-cervical-spine-fracture-after-head-on-motor-vehicle-collision-a-case-report/